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Compelling Stories, if Not Literature

“A poet,” James Dickey once said, “is someone who stands outside in the rain hoping to be struck by lightning.” But what about the obvious follow-up question, regarding people who happen to be out in the rain and happen to be struck by lightning? Should each of them then become a poet — or perhaps the author of a slim volume of nonfiction?

The general consensus these days seems to be yes, absolutely. Hence the outpouring of health-related memoirs by hapless targets of violent celestial wrath: the cancer survivors, the rare-disease survivors and the transplantees; the abused, the depressed, the addicted; the obese and the anorexic; the weathered veterans of lifelong health misery and the startled victims of a single bolt from the blue. Not to mention their friends and relations.

Few of these efforts rise to the level of great literature, but that may be beside the point. Should memoirs of illness be held to the same standards as other writing? Or do reader and writer form a different relationship when the health crisis of one becomes the theater of the other, a relationship in which a reviewer has very little business meddling?

After years spent in the company of the sick, I know one thing for sure: there is no story out there that is not a great story. Every single one contains enough pathos, courage, comedy and surprise to power it right to the top of the charts. (This is hardly an original insight: a whole new area of graduate study titled “Narrative Medicine” is based on exactly this premise.)

And so Nancy Makin of Grand Rapids, Mich., has a wonderful story to tell about her transformation from a 703-pound recluse into a slender, successful motivational speaker. So does Tracy White, who as a suicidal, bulimic New York City teenager committed herself to a mental hospital for a slow recovery. And so does Diane Currie of Lawrenceville, N.J., sick at heart as she watched her mother rapidly deteriorate from Alzheimer’s disease.

But the written word can be cruel to even the best story. None of these books comes close to succeeding according to the usual standards. The language is clumsy and full of clichés; the dialogue is stiff and unreal; the pacing is way off. Even Ms. White, who has an appealingly hip sensibility and presents her story as a graphic novel, can’t step far enough back from herself to draw the adult reader into her teenage universe.

Still, perhaps these verdicts are simply not relevant. Perhaps these books serve a different purpose from the usual, both for writer and for reader. Perhaps the reviewer should just butt out.

A fraught debate addresses the question of whether writing about an illness has actual therapeutic value, bringing not just a little flush of accomplishment but measurable improvement in objective clinical signs of disease. As with many similar questions from the fuzzier hinterlands of medicine, the experts differ bitterly over this one.

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Tracy White

In a pivotal 1999 study reported in The Journal of the American Medical Association, researchers asked patients with asthma or rheumatoid arthritis to write short essays about traumatic life experiences (few chose to write specifically about their illness). Compared with a control group given a writing task with no emotional content, the subjects had noticeable improvements in both subjective and objective signs of illness that endured for months after the writing exercise was over.

Did confronting emotion head-on improve immune function and soothe the disease? Did it simply remind the sick people to take better care of themselves? The researchers shrugged and called for further study to elucidate, but many of the subsequent studies found no effects from writing at all.

In 2006 German researchers published a detailed analysis in the online journal Psycho-Social-Medicine, reviewing dozens of studies and concluding that it was all a pipe dream: writing did nothing to heal, and statements to the contrary would simply “misdirect” the public with “expectations and hopes not likely to be met.”

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But unlike many other controversial therapies, one that involves a keyboard and a little soul-searching probably can’t really hurt. And perhaps it does help, even with nothing more than a boost in morale. So can we really call books that may serve a therapeutic purpose failures? Hardly: they are successes before they hit the stores.

And then, when they do go on sale, these books bisect the reading public as very few other books can. Most readers approach them as they do all reading matter, for entertainment and education, muttering all the while, “There but for the grace of God go I.” But some will finish the first chapter and say: “That’s me. There go I.”

And for those thousands or dozens — or maybe just two or three — who find themselves in the pages, well, it doesn’t take a randomized controlled trial to know that the book will be a great read, no matter what anyone else says.

I know this all firsthand from the other giant pile on my desk, the one written by doctors telling their own stories. Most of these books aren’t great literature either: the great majority are sentimental and predictable, and a few manage to be as pedantic, self-important and annoying as, one ventures, their authors must be in person.

But I have a soft spot for them all. Take a collaboration by Dr. John Castaldo and Dr. Lawrence Levitt, two neurologists in Allentown, Pa., who have stitched together a loose collection of vignettes about their professional lives.

I could say these two write with great realism and good humor about all the usual frustrations of clinical practice, that their tone is appealing and their prose readable, that their anecdotes give a dead-on accurate description of the ridiculously difficult struggle to do right by patients.

I could say all this, or I could just be honest and say, “There go I,” and let the rest of you all take it from there.

A version of this review appears in print on June 29, 2010, on Page D5 of the New York edition with the headline: Compelling Stories, If Not Literature. Order Reprints|Today's Paper|Subscribe